Hypermagnesemia in Clinical Practice

Neurological manifestations of hypermagnesemia: a narrative review

Hypermagnesemia is a rare but potentially fatal electrolyte disorder. High serum magnesium levels have been associated with the development of neurological manifestations such as dysautonomia, muscle weakness, respiratory failure, and altered level of consciousness from drowsiness to coma. Although rare, some subjects, such as those with chronic renal failure and those taking magnesium supplements or medications, are at risk of developing this condition. Recognizing this electrolyte alteration promptly allows for an immediate initiation of a therapeutic strategy that is often resolutive when addressed in time. This paper aims to review the neurological complications associated with hypermagnesemia, their pathophysiology, and management.

F. M, S. D, M. A. M. C. G, F. A, C. B, F. B. S, J. E. V. Optimal Dose of Magnesium Sulfate Infusion in Obese Patients: A Double-Blind Randomized Trial

Background: Magnesium sulfate reduces opioid use and its associated side effects. However, no consensus exists on whether the optimal dosing should be based on actual body weight or adjusted ideal body weight. The primary objective of this study was to compare postoperative analgesia after magnesium sulfate infusion, using doses calculated based on actual body weight versus adjusted ideal body weight. Methods: This prospective, randomized, double-blind, controlled clinical trial included 75 participants who underwent target-controlled intravenous general anesthesia. The participants were divided into three groups: a control group (CG), a group receiving magnesium sulfate calculated by actual body weight (AWG), and a group receiving magnesium sulfate calculated based on the adjusted ideal body weight (IWG). Results: The AWG had significantly lower pain scores than the CG (p < 0.001) and IWG (p=0.017). Opioid use was similar between the AWG and IWG, but significantly higher in the CG (AWG = IWG, p=0.08; CG > AWG, p < 0.001; CG = IWG, p 0.03). The increase in magnesium concentration did not reach clinically relevant levels. Neuromuscular blockade latency decreased in the groups receiving magnesium sulfate (p < 0.001 in both comparisons) compared to the CG. Conclusion: Calculating the dose of magnesium sulfate based on actual body weight enhances postoperative analgesia. The increase in magnesium concentration was not clinically significant and did not interfere with the action of cisatracurium in the groups receiving magnesium sulfate. Trial Registration: ClinicalTrials.gov identifier: NCT04645719.

Impaired consciousness due to hypermagnesemia associated with stercoral colitis: report of a rare case

BACKGROUND

Hypermagnesemia is a rare electrolyte abnormality that is difficult to diagnose because its symptoms are nonspecific. In addition to magnesium administration, renal dysfunction is often a major risk factor associated with the condition; severe intestinal dysfunction is also a known risk factor. However, no cases of hypermagnesemia were observed in the absence of magnesium administration.

CASE PRESENTATION

A 75-year-old woman with cognitive impairment presented to the emergency department with impaired consciousness. The patient was comatose and hypotensive and had a markedly distended abdomen. Her blood pressure was stabilized with infusion; however, the improvement in consciousness was insufficient and somnolence continued. Abdominal computed tomography revealed marked colonic distension due to fecal impaction in the rectum, with wall thickening and pericolonic fat stranding. Blood tests revealed elevated levels of C-reactive protein (10.2 mg/dL), lactate (6.04 mmol/L), and magnesium (5.9 mg/dL). There was no history of ingestion of magnesium-containing preparations; thus, the patient was diagnosed with hypermagnesemia associated with stercoral colitis. Magnesium levels and consciousness improved with the administration of calcium preparations, diuretics, antibiotics, and defecation control.

CONCLUSIONS

Severe bowel dysfunction can cause hypermagnesemia, even in the absence of magnesium administration.

Ionized and total magnesium levels and health outcomes in patients with type 2 diabetes mellitus

Magnesium (Mg) is a vital trace element in cellular processes, including glucose metabolism and insulin action. This study aimed to assess the prevalence of dysmagnesemia among patients with type 2 diabetes mellitus (T2DM) and its relationship with glycaemic control and diabetic complications. A cross-sectional study was conducted at Sultan Qaboos University Hospital (SQUH) from August 1, 2023, to April 30, 2024. The study included adult patients with T2DM treated with oral hypoglycemic agents (OHA), insulin, glucagon-like-peptide 1 (GLP-1) injections or their combinations. Both ionized (iMg) and total (tMg) concentrations were measured and the iMg/tMg ratio was calculated. A total of 329 patients with T2DM of which179 females (54.4%), were studied. Hypomagnesemia was observed in 10.0% based on iMg concentrations and 56.2% based on tMg concentrations, while hypermagnesemia was observed in 11.85% (iMg) and 1.82% (tMg). A positive correlation was found between iMg and tMg (r = 0.589, p < 0.01). Hypermagnesemia was associated with higher serum creatinine concentrations (p < 0.01) and lower estimated glomerular filtration rate (eGFR) (p = 0.026). An iMg/tMg ratio above 80% was associated with elevated HbA1c levels, while ratios below 60% were associated with diabetic retinopathy and hypertension. Dysmagnesemia was common among patients with T2DM. The iMg/tMg ratio was associated with diabetic control and presence of complications. The iMg/tMg ratio could be further studied as a potential marker for glycemic control.

Clinical nutrition in patients with Acute Kidney Injury: Traditional approaches and emerging perspectives

Acute kidney injury (AKI) is a complex clinical syndrome characterized by a rapid decline in kidney function, often resulting in complex metabolic and hormonal derangements. A major concern in managing AKI patients is the development of protein energy wasting (PEW), a condition marked by loss of lean body mass and negative impact on overall health outcomes. Additionally, the need of Kidney Replacement Therapy (KRT) for the most severe forms of AKI may further increase the risk of PEW, with a substantial impact on fluid and metabolic balance. Adequate nutritional support is crucial in the management of AKI, as it plays a pivotal role in muscle mass preservation, morbidity reduction and recovery of renal function. This paper aims to evaluate the current evidence regarding nutritional strategies in AKI patients, focusing on energy and protein requirements, timing and route of nutritional intervention, and impact of individualized nutrition plans on PEW prevention and management.

Minerals and Human Health: From Deficiency to Toxicity

Minerals are essential nutrients that play critical roles in human health by regulating various physiological functions. Examples include bone development, enzyme function, nerve signaling, and the immune response. Both the deficiencies and toxicities of minerals can have significant health implications. Deficiencies in macrominerals such as calcium, magnesium, and phosphate can lead to osteoporosis (associated with falls and fractures), cardiovascular events, and neuromuscular dysfunction. Trace mineral deficiencies, such as iron and zinc. Selenium deficiency impairs oxygen transport, immune function, and antioxidant defenses, contributing to anemia, delaying wound healing, and increasing susceptibility to infectious diseases. Conversely, excessive intake of minerals can have severe health consequences. Hypercalcemia can cause kidney stones and cardiac arrhythmias as well as soft-tissue calcification, whereas excessive iron deposition can lead to oxidative stress and organ/tissue damage. Maintaining adequate mineral levels through a balanced diet, guided supplementation, and monitoring at-risk populations is essential for good health and preventing disorders related to deficiencies and toxicities. Public health interventions and education about dietary sources of minerals are critical for minimizing health risks and ensuring optimal well-being across populations. While a comprehensive analysis of all macro and micronutrients is beyond the scope of this article, we have chosen to focus on calcium, magnesium, and phosphate. We summarize the consequences of deficiency and the adverse events associated with the overconsumption of other minerals.

Hypermagnesemia- and Hyperphosphatemia-Associated Cardiac Arrest after Injection of a Novel Magnesium-Based Bone Cement in Spinal Surgery

We report a case of pulseless electrical activity (PEA) associated with profound hypermagnesemia immediately after cementation of a novel magnesium-based cement in spine surgery. During T8 to T12 posterior instrumentation and decompression laminectomy for vertebral metastasis secondary to lung cancer, a 61-year-old Chinese woman developed sudden hypotension and went into PEA immediately after injection of a novel magnesium-based cement. Intraoperative fluoroscopic imaging did not show any notable cement extravasation. Resuscitation using intravenous epinephrine with five doses of 1-mg epinephrine in 1:10,000 dilution was instituted, and the patient had return of spontaneous circulation after 5 minutes. After successful resuscitation, surgery was expedited and completed. Intraoperative and postoperative investigations were notable for profound hypermagnesemia and hyperphosphatemia requiring diuresis. No echocardiographic or computerized tomographic evidence of pulmonary embolism was found. The patient was transferred to the surgical intensive care unit and remained on dual inotropic support over the next few days. She subsequently weaned off inotropic support and electrolyte imbalances resolved before making a full recovery. This case report demonstrates the severe magnesium toxicity and PEA related to the use of novel magnesium-based cement in spine surgery. Further studies need to be conducted to understand the potential complications related to its use and compare them to the standard bone cement implantation syndrome.

Dysmagnesemia with acute kidney injury among older adults: clinical characteristics and prognostic importance

PURPOSE

The relationship between dysmagnesemia and all-cause mortality probability in individuals with acute kidney injury (AKI) have not been investigated. In this study, we evaluated the correlation of varying magnesium levels with mortality in older adults undergoing AKI.

PATIENTS AND METHODS

Older adults receiving treatment at the Chinese PLA General Hospital between 2007 and 2018 were retrospectively recruited. All-cause mortality was evaluated at four preset magnesium concentrations: <0.8, 0.8-0.9, 0.9-1.0, and ≥ 1.0 mmol/L. Using multivariable-adjusted Cox assessment, the all-cause mortality risk was approximated by setting the reference magnesium concentration at 0.8-0.9 mmol/L.

RESULTS

Totally 744 participants were enrolled, whose median age was 88 years, with most of them being male (94.2%). Among them, 184 patients were assigned into the < 0.8 mmol/L group, 156 into the 0.8-0.9 mmol/L group, 206 into the 0.9-1.0 mmol/L group, and 198 into the ≥ 1.0 mmol/L group. After 28 days, the mortality rates in the four strata were 26.6, 17.9, 17.5, and 37.4%, respectively. The corresponding mortalities after 90 days were 42.4, 23.7, 26.7, and 45.5%, respectively. Compared with patients who had magnesium levels of 0.8-0.9 mmol/L, those with magnesium levels < 0.8 mmol/L (P = 0.048), and ≥ 1.0 mmol/L (P < 0.001) exhibited higher 28-day mortalities. Significant correlations also showed that patients with magnesium levels < 0.8 mmol/L (P = 0.017) and ≥ 1.0 mmol/L (P < 0.001) were significantly related to the increased 90-day mortality.

CONCLUSION

Magnesium levels outside the interval of 0.8-1.0 mmol/L were related to the higher risks of 28- and 90-day mortalities among older adults with AKI.

Prevalence, clinical characteristics, and health outcomes of dysmagnesemia measured by ionized and total body concentrations among medically hospitalized patients

Ionized Mg (iMg) may offer a more reliable indicator of Mg status during acute illness than total Mg (tMg) concentrations. This study aimed to determine the prevalence of dysmagnesemia and their relationship using iMg and tMg. The clinical and biochemical characteristics as well as health outcomes and their association with iMg and tMg were also assessed. A prospective study including all eligible adult patients (≥18 years) who were hospitalized in the General Internal Medicine unit at Sultan Qaboos University Hospital (SQUH) for 3.5 months in 2023. The iMg and tMg concentrations were collected on all at the admission. In total 500 patients were included (females 49.2%) with a median age of 64.5 years (IQR: 48-77). The prevalence of hypomagnesemia and hypermagnesemia by iMg concentrations was 3.4% and 26.6%, respectively, while by tMg concentrations 13.2% and 11.0%, respectively. The agreement between both measurements was strong (r=0.665, p<0.01). An increased tMg concentration was independently associated with high dependency units' admission (adjusted odds ratio (aOR): 4.34, 95%CI: 1.24-15.06, p=0.02) and cardiac arrest (aOR: 14.64, 95%CI: 3.04-70.57, p<0.01), and 6-month all-cause mortality (aOR: 11.44, 95%CI: 2.46-53.17, p<0.01). During follow-up hypermagnesemia using tMg had a higher mortality compared to other groups (hazard ratio (HR): 1.82, 95%CI: 1.11-3.01, p=0.02) while no significant findings were demonstrated using iMg concentrations. iMg and tMg concentrations had a strong correlation that might be supporting the potential use of point-of-care devices. Multivariant regression analysis showed that hypermagnesemia by tMg was associated with adverse outcomes. However, the generalizability of the study findings should be taken with caution and the difference in the associations with outcomes highlight the importance of further research to examine the complex associations and impacts of dysmagnesemia in various clinical settings.

Effects of Iron, Copper, Zinc, and Magnesium on Chronic Widespread Pain: A Two-Sample Mendelian Randomization

Background: Chronic widespread pain (CWP) affects approximately 10% of the adult population globally, causing significant physical and psychological distress. Micronutrients, such as iron, copper, zinc, and magnesium, are essential in various physiological functions, and their imbalances may impact pain perception and chronic pain conditions. Methods: This study used Mendelian randomization (MR) to investigate the causal relationships between micronutrient levels and CWP. Data were obtained from genome-wide association studies (GWASs) for iron, copper, zinc, and magnesium, and CWP data were sourced from large-scale GWASs with 461,857 European participants. Genetic variants were used as instrumental variables to infer causal relationships, minimizing confounding factors. Results: MR analysis revealed a significant association between higher iron levels and an increased risk of CWP (IVW, OR 1.01, 95% CI: 1.00-1.01, p = 0.029). This finding was supported by the weighted median and MR-Egger methods. No significant associations were found for copper, zinc, and magnesium levels. Conclusions: These results suggest that iron levels may influence pain perception and chronic pain conditions. Balanced iron levels are crucial for managing chronic pain. Regular monitoring and personalized treatment plans could benefit individuals with CWP. Further research is needed to understand the mechanisms linking micronutrient levels to chronic pain and to develop targeted therapeutic interventions.

High serum magnesium level is associated with increased mortality in patients with sepsis: an international, multicenter retrospective study

Magnesium imbalances commonly exist in septic patients. However, the association of serum magnesium levels with mortality in septic patients remains uncertain. Herein, we elucidated the association between serum magnesium and all-cause mortality in septic patients from American and Chinese cohorts by analyzing data from 9099 patients in the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database and 1727 patients from a university-affiliated hospital' intensive care unit in China. Patients in both cohorts were categorized into five groups based on serum magnesium quintiles from the MIMIC-IV dataset. Patients with higher serum magnesium levels exhibited an increased risk of 28-day mortality in both cohorts. The restricted cubic spline (RCS) curves revealed a progressively elevated risk of 28-day mortality with increasing serum magnesium in MIMIC-IV cohort, while a J-shaped correlation was observed in institutional cohort. Our findings have validated the association between high serum magnesium and high mortality in sepsis across different races and medical conditions. Serum magnesium levels might be useful in identifying septic patients at higher mortality risk.

A Comprehensive Review on Understanding Magnesium Disorders: Pathophysiology, Clinical Manifestations, and Management Strategies

Magnesium is vital in a broad spectrum of physiological processes, including enzyme activity, energy production, and neuromuscular function. Despite its crucial role, magnesium disorders - comprising both deficiency (hypomagnesemia) and excess (hypermagnesemia) - are frequently underrecognized and inadequately managed in clinical practice. Magnesium deficiency is widespread, particularly among populations with chronic illnesses, the elderly, and those experiencing malnutrition, often leading to significant neuromuscular, cardiovascular, and metabolic complications. Conversely, hypermagnesemia, though less common, poses serious risks, especially in individuals with impaired renal function or those receiving high doses of magnesium supplements or medications. This review comprehensively examines magnesium disorders, detailing their pathophysiology, clinical manifestations, and management strategies. It highlights the essential functions of magnesium in maintaining cellular integrity, cardiovascular health, and bone structure and discusses the global prevalence and risk factors associated with magnesium imbalances. By offering insights into the current understanding of magnesium homeostasis and its disruptions, this review aims to enhance the awareness and treatment of magnesium-related conditions, ultimately improving patient outcomes across diverse clinical settings.

Case report: Near-fatal hypermagnesemia resulting from the use of Epsom salts in a patient with normal renal function

Hypermagnesemia commonly occurs in patients with renal dysfunction. Diagnosing hypermagnesemia represents a challenge due to its rarity and the absence of routine monitoring of magnesium levels. Furthermore, the lack of awareness among clinicians regarding this uncommon condition frequently leads to delayed diagnoses. Few patients survive with a serum magnesium level exceeding 7 mmol/L. This article presents a case study of near-fatal hypermagnesemia resulting from the oral administration of Epsom salts in a patient with normal renal function. A 60-year-old female presented to the gastroenterology department on Oct. 6, 2023, with a 3-day history of black stools. She underwent subtotal gastrectomy in 2005 and has a stable history of nephrotic syndrome. To investigate the cause of her bleeding, electronic gastroscopy and colonoscopy were scheduled for Oct. 11, 2023. She experienced a sudden loss of consciousness 30 min after the ingestion of Epsom salts. The attending physician suspected a severe magnesium poisoning. She was promptly administered calcium gluconate, underwent tracheal intubation with ambu bag ventilation, and received early continuous renal replacement therapy (CRRT). Swift diagnosis and CRRT contributed to a reduction in her serum magnesium levels from an initial 8.71 mmol/L to 1.35 mmol/L, leading to a remarkable improvement in the toxic symptoms associated with hypermagnesemia. Subsequently, she was managed in the gastroenterology department, with gastroscopy revealing bleeding from the gastrointestinal anastomotic ulcer. Following conservative treatments including acid suppression, stomach protection, and hemostasis, her symptoms improved, and she was successfully discharged. This study aims to alert clinicians to the possibility of hypermagnesemia in individuals with normal renal function. Physicians should exercise caution when prescribing Epsom salts to patients with underlying gastrointestinal conditions. If necessary, alternative drug therapies may be considered to mitigate the risk of hypermagnesemia. Timely intervention is pivotal in averting life-threatening complications linked to hypermagnesemia.

Metals on the Menu-Analyzing the Presence, Importance, and Consequences

Metals are integral components of the natural environment, and their presence in the food supply is inevitable and complex. While essential metals such as sodium, potassium, magnesium, calcium, iron, zinc, and copper are crucial for various physiological functions and must be consumed through the diet, others, like lead, mercury, and cadmium, are toxic even at low concentrations and pose serious health risks. This study comprehensively analyzes the presence, importance, and consequences of metals in the food chain. We explore the pathways through which metals enter the food supply, their distribution across different food types, and the associated health implications. By examining current regulatory standards for maximum allowable levels of various metals, we highlight the importance of ensuring food safety and protecting public health. Furthermore, this research underscores the need for continuous monitoring and management of metal content in food, especially as global agricultural and food production practices evolve. Our findings aim to inform dietary recommendations, food fortification strategies, and regulatory policies, ultimately contributing to safer and more nutritionally balanced diets.

Efficacy and Safety of Intravenous Magnesium Sulfate in Spinal Surgery: A Systematic Review and Meta-Analysis

Optimizing pain management in spinal surgery is crucial for preventing adverse events due to delayed mobilization. Magnesium sulfate has potential benefits in spinal surgery because of its analgesic properties and modulation of neurotransmitters and autonomic nervous system. Existing evidence regarding the use of magnesium sulfate is partial and controversial, necessitating a comprehensive meta-analysis to evaluate its efficacy and safety. The aim of this study was to conduct a comprehensive meta-analysis to evaluate the efficacy and safety of magnesium sulfate in spinal surgery compared to other available options. This meta-analysis adhered to the PRISMA guidelines. Patients undergoing spinal surgery were included, with the intervention group receiving intravenous magnesium sulfate (MS) at various doses or combinations, whereas the comparison group received other alternatives or a placebo. The efficacy and safety outcomes were assessed. Data were collected from multiple databases and analyzed using Review Manager version 5.4. Heterogeneity was assessed and fixed- or random-effects models were applied. The meta-analysis included eight studies (n = 541). Magnesium sulfate demonstrated significant reductions in pain at 24 h (MD -0.20, 95% CI: -0.39 to -0.02) and opioid consumption (SMD -0.66, 95% CI: -0.95 to -0.38) compared to placebo. Additionally, a decrease in the use of muscle relaxants (SMD -0.91, 95% CI: -1.65 to -0.17) and remifentanil (SMD -1.52, 95% CI: -1.98 to -1.05) was observed. In contrast, an increase in extubation time (MD 2.42, 95% CI: 1.14 to 3.71) and verbal response (MD 1.85, 95% CI: 1.13 to 2.58) was observed compared to dexmedetomidine. In conclusion, magnesium sulfate administration in spinal surgery reduced pain and opioid consumption, and prolonged orientation and verbal response. No significant differences in blood pressure or heart rate were observed between the groups.

Hypermagnesemia Complicated by Acute Flaccid Paralysis, Case Report

Hypermagnesemia is a rare electrolyte abnormality observed in the clinical setting. Patients with this condition can present with a variety of symptoms, depending on the level of serum magnesium. Hypermagnesemia is rarely complicated by weakness of the extremities. We report the case of 32 years old female patient who presented with bilateral upper- and lower-extremity weakness due to hypermagnesemia. Following correction of the serum magnesium level, extremity weakness subsided, and the patient was discharged with improvement. Here, we discuss the delay in the diagnosis and management of this type of clinical presentation.

Prevalence of Dysmagnesemia among Patients with Diabetes Mellitus and the Associated Health Outcomes: A Cross-Sectional Study

Introduction: Magnesium is a vital intracellular cation crucial for over 320 enzymatic reactions related to energy metabolism, musculoskeletal function, and nucleic acid synthesis and plays a pivotal role in human physiology. This study aimed to explore the prevalence of dysmagnesemia in patients with diabetes mellitus and evaluate its correlations with glycemic control, medication use, and diabetic complications. Methods: A cross-sectional study was conducted at Sultan Qaboos University Hospital, including 316 patients aged 18 years or older with diabetes mellitus. Data included demographics, medical history, medications, and biochemical parameters. Serum total magnesium concentrations were measured, and dysmagnesemia was defined as magnesium ≤ 0.69 mmol/L for hypomagnesemia and ≥1.01 mmol/L for hypermagnesemia. Results: The prevalence of hypomagnesemia in patients with diabetes was 17.1% (95% CI: 13.3-21.7%), and hypermagnesemia was 4.1% (95% CI: 2.4-7.0%). Females were significantly overrepresented in the hypomagnesemia group, while the hypermagnesemia group showed a higher prevalence of hypertension, retinopathy, an increased albumin/creatinine ratio, chronic kidney disease (CKD), elevated creatinine levels, and a lower adjusted calcium concentration. The multinominal logistic regression exhibited that the female sex and higher serum-adjusted calcium were independent risk factors of hypomagnesemia. In contrast, the presence of hypertension, higher levels of albumin/creatinine ratio, and stage 5 CKD were independent risk factors of hypermagnesemia. Conclusions: Hypomagnesemia was common among patients with diabetes mellitus; however, hypermagnesemia was associated with microvascular complications.

Minerals and the Menstrual Cycle: Impacts on Ovulation and Endometrial Health

The role of minerals in female fertility, particularly in relation to the menstrual cycle, presents a complex area of study that underscores the interplay between nutrition and reproductive health. This narrative review aims to elucidate the impacts of minerals on key aspects of the reproductive system: hormonal regulation, ovarian function and ovulation, endometrial health, and oxidative stress. Despite the attention given to specific micronutrients in relation to reproductive disorders, there is a noticeable absence of a comprehensive review focusing on the impact of minerals throughout the menstrual cycle on female fertility. This narrative review aims to address this gap by examining the influence of minerals on reproductive health. Each mineral's contribution is explored in detail to provide a clearer picture of its importance in supporting female fertility. This comprehensive analysis not only enhances our knowledge of reproductive health but also offers clinicians valuable insights into potential therapeutic strategies and the recommended intake of minerals to promote female reproductive well-being, considering the menstrual cycle. This review stands as the first to offer such a detailed examination of minerals in the context of the menstrual cycle, aiming to elevate the understanding of their critical role in female fertility and reproductive health.

Magnesium Is a Vital Ion in the Body-It Is Time to Consider Its Supplementation on a Routine Basis

The importance of maintaining proper magnesium intake and total body magnesium content in preserving human health remains underappreciated among medical professionals and laymen. This review aimed to show the importance of hypomagnesemia as a modifiable risk factor for developing disease processes. We searched the PubMed database and Google Scholar using the keywords 'magnesium', 'diabetes', 'cardiovascular disease', 'respiratory disease', 'immune system', 'inflammation', 'autoimmune disease', 'neurology', 'psychiatry', 'cognitive function', 'cancer', and 'vascular calcification'. In multiple contexts of the search terms, all reviews, animal experiments, and human observational data indicated that magnesium deficiency can lead to or contribute to developing many disease states. The conclusions of several in-depth reviews support our working hypothesis that magnesium and its supplementation are often undervalued and underutilized. Although much research has confirmed the importance of proper magnesium supply and tissue levels, simple and inexpensive magnesium supplementation has not yet been sufficiently recognized or promoted.

Flapping Tremor: Unraveling Asterixis-A Narrative Review

Asterixis is a subtype of negative myoclonus characterized by brief, arrhythmic lapses of sustained posture due to involuntary pauses in muscle contraction. We performed a narrative review to characterize further asterixis regarding nomenclature, historical aspects, etiology, pathophysiology, classification, diagnosis, and treatment. Asterixis has been classically used as a synonym for negative myoclonus across the literature and in previous articles. However, it is important to distinguish asterixis from other subtypes of negative myoclonus, for example, epileptic negative myoclonus, because management could change. Asterixis is not specific to any pathophysiological process, but it is more commonly reported in hepatic encephalopathy, renal and respiratory failure, cerebrovascular diseases, as well as associated with drugs that could potentially lead to hyperammonemia, such as valproic acid, carbamazepine, and phenytoin. Asterixis is usually asymptomatic and not spontaneously reported by patients. This highlights the importance of actively searching for this sign in the physical exam of encephalopathic patients because it could indicate an underlying toxic or metabolic cause. Asterixis is usually reversible upon treatment of the underlying cause.

The Integral Role of Magnesium in Muscle Integrity and Aging: A Comprehensive Review

Aging is characterized by significant physiological changes, with the degree of decline varying significantly among individuals. The preservation of intrinsic capacity over the course of an individual's lifespan is fundamental for healthy aging. Locomotion, which entails the capacity for independent movement, is intricately connected with various dimensions of human life, including cognition, vitality, sensory perception, and psychological well-being. Notably, skeletal muscle functions as a pivotal nexus within this intricate framework. Any perturbation in its functionality can manifest as compromised physical performance and an elevated susceptibility to frailty. Magnesium is an essential mineral that plays a central role in approximately 800 biochemical reactions within the human body. Its distinctive physical and chemical attributes render it an indispensable stabilizing factor in the orchestration of diverse cellular reactions and organelle functions, thereby rendering it irreplaceable in processes directly impacting muscle health. This narrative review offers a comprehensive exploration of the pivotal role played by magnesium in maintaining skeletal muscle integrity, emphasizing the critical importance of maintaining optimal magnesium levels for promoting healthy aging.

The Laboratory and Clinical Perspectives of Magnesium Imbalance

Magnesium (Mg2+) is a predominantly intracellular cation that plays significant roles in various enzymatic, membrane, and structural body functions. As a calcium (Ca2+) antagonist, it is imperative for numerous neuromuscular activities. The imbalance of body Mg2+  concentration leads to clinical manifestations ranging from asymptomatic to severe life-threatening complications. Therefore, the contribution of Mg2+ measurement regarding various laboratory and clinical aspects cannot be ignored. Mg2+ is often described as the forgotten analyte. However, its close relationship with body potassium (K+), Ca2+, and phosphate homeostasis proves that Mg2+ imbalance could co-exist as the root cause or the consequence of other electrolyte disorders. Meanwhile, several preanalytical, analytical, and postanalytical aspects could influence Mg2+ measurement. This review highlights Mg2+ measurement's laboratory and clinical issues and some analyte disturbances associated with its imbalance. Understanding this basis could aid clinicians and laboratory professionals in Mg2+ result interpretation and patient management.